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The words are hurled down the hall and around the corner. They land limply in the room set aside for medical providers. I look up from my computer and glance over at my resident. She shrugs, unconcerned. I shrug in response. I am two rotations into my third year, and I have already come to live by the “not my patient, not my problem” mantra. I swivel in the chair and click through the electronic medical record. A new patient has arrived. The first line of the note reads: Charlotte is a 19 year old female who presents to clinic with a chief complaint of breast pain.

“Hey Kat,” my attending calls. He stands, shifting his weight from left to right, at the doorway. His ever-present half-smirk/half-smile is stripped from his face. He seems uncharacteristically uneasy. “Can you go see Room 4?”

“I’m still finishing the note on the last patient so I was going to let the student see this one. We already discussed a differential.”

“Sure,” he says. “Go see her now.”

“EMR says she’s still in triage,” I say.

“Go see her now,” he repeats.

Charlotte is on the ground, arms wrapped around her leg, and weeping. “Hi, are you Charlotte?” I ask when I bend down to help her up.

“Don’t touch me!” She screams and pushes me away.

Her mother, who I had not noticed before, says, “She doesn’t like to be touched” over and over.

I stand with my clipboard and blank sheets of paper shaking in my hand. “Can I help with anything?”

“Get her to shut up! Get her to leave! I want to go home!”

Her mother looks up at me and says, “Give us a moment. I’m going to get her in the room and you can come back.”

I nod, hands still shaking, and walk around the corner.

The crying dies down. I knock on the door. I sit in the chair in front of the computer. Charlotte is on the examination table. She has low-cut brown hair and tears running down her face; she’s dressed in an oversized olive green jacket, loosely fit blue jeans, and black Converse.

I introduce myself and apologize.

She glares.

“Can you tell me what brings you in today, Charlotte?”

“Isn’t there a nurse who tells you that stuff?” The words, sharp, fall from her lips.

“Charlotte, you don’t need to be that way,” her mom intervenes. Her mom is seated to the left of me. She has librarian glasses and black curly hair. She seems nervous but warm. I find myself turning toward her.

“I’m under the impression you’re here for breast pain, is that correct?”

“The fuck yes I have breast pain. Look at me. These are huge. I’m in pain all the time.”

I look at her. Her clothes are so loose fitting that I find it difficult, no, impossible to confirm her statement.

“That sounds terribly uncomfortable. When did the pain start?”

“This is a waste of time, she’s not going to believe anything I say.”

Her mother jumps in: “To my knowledge it started when she was in fifth grade when she was started on risperidone. Her breasts started swelling and grew far too quickly and the pain is always worse when she is on her cycle.”

“Don’t talk about my cycle.”

“Risperidone? For what?”

“Oh she’s tried so many medications. She has anxiety, intractable OCD for which she had a gamma capsulotomy, depression, Asperger’s, and something else.…”

I take a muddled history from her mother and I look at Charlotte when I remember what she said earlier: This is a waste of time, she’s not going to believe anything I say. “Charlotte, I want you to know that I’m on your side. I know it could seem as though I doubt you because I’m asking you guys a lot of questions, but I just want to get all the details straight. I want to make sure we take excellent care of you.”

She tears up and nods.

Her mother leaves the room to speak with my attending and so we are left alone. “So Charlotte, ultimately what do you want?”

“I want my breasts removed. I hate them. They do not belong to me.”

“Your mom mentioned a reduction.”

“She doesn’t understand. I need these gone.”

“Okay, I’m not sure if my attending does that. You may have to see a plastic surgeon but I’ll ask, okay?”

“Thank you.”

We sit in a silence.

“Can I tell you something?”

“Anything,” I say.

“Some boys at my high school keep sending me notes that they are going to rape me. I think they like my tits.”

“Charlotte, that is not okay! Have you reported them?”

“Yeah, they don’t believe me. They can’t understand why boys like that would be interested in me.”

“I imagine that’s stressful. Do you talk with your mother about this stuff?”

“No.”

“Okay, I understand. What are some things you do to take your mind off of such things?”

“I draw.” I smile in response. “I have my sketchbook with me if you want to see.” I nod.

She opens the book to a sketch of a male, fashionably clad. “Is that someone you know? He’s incredibly well dressed!”

“That’s me.”

“Charlotte, I have to ask. Is this how you see yourself as masculine or perhaps even male?”

“Everything is just between us, correct?”

I nod.

“How do you feel about transgender people?”

“One of my closest friends is transitioning.”

“I’ve never told anyone this, but I’m transgender. I don’t want my breasts at all but that’s not the only reason I want a surgery. They really do hurt.”

I pause. How do you communicate to someone how privileged you feel to be let into their life? How do you make sure they believe you?

“Charlotte, I am so happy you shared that with me. I know that wasn’t easy and I know it’s not easy in this political climate, especially here in the South, to find people who will support your journey.”

She starts crying. She asks: “You care about me? You understand me?”

“Can I give you a hug?” I am fully aware that there is nothing my attending will do for her aside from put in a referral for plastic surgery.

2017 Hope Babette Tang Humanism in Healthcare Essay Contest

Each year, the Arnold P. Gold Foundation holds an essay contest to encourage medical students to reflect on their experiences and engage in narrative writing. The contest, launched in 1999 and open to any student enrolled in an accredited U.S./Canadian medical school, asks students to respond to a specific prompt in a 1,000-word essay.

The 2017 prompt was “Compassion becomes real when we recognize our shared humanity” (Pema Chodron). Using the quote as a reflective prompt, write an essay based on a true story or anecdote that illustrates an experience where you or a team member worked to ensure that humanism (compassionate, collaborative, scientifically excellent care) was at the core of medical practice.

Almost 200 essays were submitted and reviewed by a distinguished panel of judges ranging from esteemed medical professionals to notable authors. The top 3 essays were selected along with 10 honorable mentions. Winning essays were published on the Arnold P. Gold Foundation Web site (www.gold-foundation.org) and will be published in consecutive fall issues of Academic Medicine.

The contest is named for Hope Babette Tang-Goodwin, MD, who was an assistant professor of pediatrics. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor, and deep compassion for her patients. She was an exemplar of humanism in medicine.

The Arnold P. Gold Foundation, founded in 1988, is dedicated to creating the gold standard in health care—compassionate, collaborative, and scientifically excellent care—to support clinicians throughout their careers, so the humanistic passion that motivates them at the beginning of their education is sustained throughout their practice.